Better heart health before the pandemic was associated with a lower risk of severe COVID-19 outcomes, according to a study published today in the Journal of the American Heart Association. Researchers found that adults with the highest heart health scores at the start of the pandemic were nearly half as likely to be hospitalized or die from COVID-19 compared to those with the lowest scores. The study analyzed data from nearly 30,000 adults without clinical cardiovascular disease, using the American Heart Association's Life's Essential 8 metric, which assesses diet, physical activity, smoking, sleep, body mass index, blood pressure, cholesterol, and blood sugar.
“COVID-19 caused 1.22 million deaths in the U.S. between March 2020 and March 2025, so it’s essential that we understand how important health components, such as heart health, relate to severity of COVID-19 infections,” said lead study author Tim Plante, M.D., M.H.S., an associate professor of medicine at the Larner College of Medicine at the University of Vermont. “Our findings suggest that the tremendous impact of COVID-19 on the U.S. could have been reduced if the general population had had better heart health prior to the onset of the pandemic.”
The analysis, part of the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), included participants from 14 U.S. studies with long-term health data. Among the 29,740 adults (average age 66, 61% women), 18% had high heart health (score 80-100), 70% moderate, and 12% low (score <50). During follow-up from March 2020 to February 2023, there were 681 severe COVID-19 cases, defined as hospitalization or death. The results showed that those with high Life's Essential 8 scores had a 46% reduction in risk of severe COVID-19 compared to those with low scores. For every 14-point increase in score, the risk dropped by 20%. Individual components associated with lower risk included more physical activity, healthier weight, optimal blood pressure, and better sleep patterns.
“The findings suggest that having a healthy heart helps the body deal with the stress of a viral infection like COVID-19,” said senior author Elizabeth C. Oelsner, M.D., Dr.P.H., associate professor of medicine at Columbia University Irving Medical Center. “In many ways, a viral infection is like a cardiac stress test, except it’s not controlled.” The study adjusted for age, sex, race, ethnicity, and vaccination status, and the benefits persisted as the pandemic evolved and vaccines became available. However, the study was observational and could not establish cause and effect. Heart health was measured only before or at the beginning of the pandemic, and changes during the pandemic were not assessed.
Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the American Heart Association’s Epidemiology Statistic Committee, who was not involved in the research, noted that the study emphasizes the importance of healthy lifestyle habits and vaccination. “Healthy lifestyle habits make a difference for preventing heart disease, which can sometimes feel like a vague and far-off goal for people, and also for more direct health benefits such as preventing adverse outcomes from respiratory infections,” Khan said. The study is published in the Journal of the American Heart Association, and more information about the Life's Essential 8 metric can be found using the My Life Check calculator.
